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General NPI Number Information
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NPI Number | 1861451858
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Entity Type | Organization
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Legal Business Name | FULLERTON RADIOLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 5528 E LA PALMA AVE STE 4A
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City | ANAHEIM
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State | CA
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Zip | 92807-2115
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Country | US
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Telephone | 714-993-2000
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Fax | 714-524-4216
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Provider Business Mailing Address
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Address Line | 3350 E BIRCH ST SUITE 105
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City | BREA
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State | CA
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Zip | 92821-6264
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Country | US
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Telephone | 714-992-0850
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Fax | 714-526-8271
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL G CHAN
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Credential | D.O.
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Telephone | 714-526-2241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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